EDs struggle with growing numbers of uninsured

Expect problem to get worse — plan accordingly’

In addition to increased numbers of mentally ill patients, EDs are seeing more uninsured patients than in the past, and the numbers could grow, warns Brian Hancock, MD, president of the American College of Emergency Physicians (ACEP) in Irving, TX. Your budget planning should factor in more uninsured patients, not just the same level you have coped with for years.

Hancock has seen the increase in his own ED. "I’ve been an emergency physician for more than 20 years, and each year, I see an increasing number of uninsured patients," he says.

But the evidence is more than anecdotal. Hancock says ACEP research indicates 72% of physicians report the number of uninsured patients they treated in the past year increased, and 79% say the figure likely will increase again during the coming year.

ED physicians also indicate that the uninsured patients they treat are more likely to delay care, suffer from illness, and put their physical and financial health in jeopardy than are patients who have health coverage, Hancock says. Too often, the ED care only is a stopgap measure that fails to address the underlying health problems, and the patients soon return to the ED, he adds.

"While we treat and stabilize them in the emergency department, after they are released, many are faced with the decision of whether to spend their money to fill a prescription, follow a recommendation to see a specialist for follow-up care, or buy groceries that week," he says. "This is a trend that ED managers have to consider when planning for the future. Unless things change dramatically, EDs will continue to face a real burden."

The emergency physicians who were surveyed rated securing specialist referrals, ensuring routine follow-up care, and filling prescriptions as the three most challenging tasks to coordinate for uninsured patients.

Contribute to overcrowding

Eighty-two percent of the physicians surveyed said their hospital’s ED functions at or over capacity on a typical weekday, and the share increases to 91% for a typical weekend.

Uninsured patients seeking nonemergency care contribute significantly to that overcrowding, Hancock says.

"This is a problem that poses practical challenges to EDs in terms of management, and planning is key," he says. "The long-range solution will be improving the health care system so that our patients don’t have to choose between proper health care and other necessities. In the meantime, you have to expect the problem to get worse, and plan accordingly."